CASE 2
A 26-year-old Argentine gelding used for trekking activities was
referred to our VTH for anuria of 36 hours’ duration and inappetence.
Both conditions developed after the horse experienced a severe fall into
a ravine during a trek in the Alps. The horse was rescued by a trained
team of colleagues that, after sedation and immobilisation, lifted the
horse with a specialised tractor equipped with a plank for horse
positioning. At initial examination in the field, the horse was
administered dexamethasone (0.2 mg/kg) and rehydrated with 5 L of Ringer
Lactate IV. The horse was kept under observation at home, two attempts
were made for catheterization which did not yield urine voiding. The
horse was then referred 36 hours later for the complaints listed above.
Upon arrival at the VTH, the horse was quiet and responsive. Clinical
examination revealed mild dehydration and superficial bruises in the
inguinal region, where ropes were applied few days before. A diagnosis
of PPID syndrome was suspected based on the observed severe
hypertrichosis, but the owner refused testing options. Rectal palpation
was normal, the urinary bladder was palpated and appeared full of urine.
Palpation did not elicit overt pain response. Ultrasound of the bladder
performed at this time was unrewarding. The gelding was thus
catheterized and is bladder emptied. Macroscopically, urines appeared
dark yellow and concentrated and no further exam was performed. The
complete blood cell count showed the presence of mild leucocytosis
characterized by absolute neutrophilia and monocytosis. Serum
biochemistry revealed hypoproteinaemia, mild hypoglycaemia and
hypocalcaemia. Serum triglycerides were also mildly elevated. Haemogas
analysis was unremarkable. Fluid therapy was initiated at maintenance
rate of 2.5 ml/kg/hour with Ringer Lactate solution together with IV 3%
glucose integration. Esomeprazole was also administered IV 0.5 mg/kg q24
hours.
After 12 hours from
referral, the patients started urinating normally. Inappetence only
partly improved despite normalization of serum triglycerides. Fluid
therapy was suspended. On day 4 of hospitalization, the gelding
developed haematuria. Urine cytology at this time showed increased red
and white blood cells as well as numerous intracellular bacteria (rods).
Transrectal ultrasonography of the bladder showed a mild increase in
thickness of the urinary bladder wall, particularly in its ventrocaudal
portion (0.54 cm, vs. 2.7 mm in the rest of the organ; reference ranges:
0.3-0.6 mm). Cystoscopy revealed a markedly inflamed and haemorrhagic
mucosa. Antimicrobial therapy was initiated with TMS PO 30 mg/kg q12 h.
Ketoprofen was also administered once IV 2.2 mg/kg. Haematuria did not
improve in the following 5 days, while urine leukocyte count did
decrease. Inappetence gradually improved. Coagulative profile identified
a prolonged prothrombin time. Treatment with topical CSP (5 grams total)
was attempted through a 2 m long Foley cathetere.
Macroscopic haematuria completely resolved in the following 48 hours.
The patient was discharged on TMS therapy to be continued for further 7
days (total 14 days of antimicrobial treatment). Urine cytology was
performed at the end of antimicrobial treatment and revealed normal
parameters.